Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans

Abstract

Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacistmanaged intervention. The study was conducted at a single Midwest VHA medical center and two affiliated communitybased outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6 months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24 months (30 month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P<.001) in diabetic patients (8.0AE14.4 mm Hg and 4.0AE9.1 mm Hg, respectively) and in nondiabetic patients (14.0AE16.4 mm Hg and 5.0AE10.0 mm Hg, respectively) following the 6-month intervention, with 54% of the total sample achieving BP control. BP control and the reduction in mean BP was maintained to a similar degree in both study groups at 12, 18, 24, and 30 months. There were no significant differences in BP at any of the follow-up periods in patients who did and did not receive the continued pharmacist intervention. This study found that BP control was maintained for at least 24 months following discontinuation of an intensive pharmacist intervention. These findings were seen in both the group that had a continued pharmacist intervention and in the group that had a one-time educational session when the intervention was discontinued. This study suggests that once BP control is achieved following a pharmacist intervention, patients can be referred back to their primary care provider for continued follow-up. J Clin Hypertens (Greenwich). 2015;17:701-708. ª 2015 Wiley Periodicals, Inc.Team-based care strategies have emerged as an effective approach for managing hypertension and other chronic conditions.1-4 For example, the Community Preventive Services Task Force recently evaluated 44 studies of team-based care (median intervention duration of 12 months) and found a mean difference of À5.4 mm Hg in systolic blood pressure (SBP), 5 while a previous systematic review found a mean difference of À9.7 mm Hg when compared with usual care. 6 The former systematic review found higher blood pressure (BP) control rates with pharmacists compared with the addition of other professionals. This finding was confirmed by another systematic review that found that nurses and pharmacists were effective in improving BP but that the effect of pharmacists was greater, with 9 mm Hg vs 5 mm Hg reductions, respectively. 7Based on this and other evidence, hypertension guidelines developed by the Veterans Health Administration (VHA) and the Department of Defense recommend the use of team-based strategies involving pharmacists to improve BP control in patients with resistant hypertention.8 While studies have...

Meta-analysis of pharmacist-led and pharmacist-physician intervention on blood pressure control

“…Overall, 15 randomized control trials with combined interventions were analyzed where Tables 1 and 2 show the summary of the included study characteristics. 10,[27][28][29][30][31][32][33][34][35][36][37][38][39] The mean intervention duration was 11 months for PPCM and 12 months for pharmacist-led intervention. Six of the studies were relatively shortterm (<9 months), and 9 of the studies were long-term (9-30 months).…”

Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression

“…Forest plot of blood pressure reduction in the intervention group compared to the control group in relation to MTM by PC for the treatment of hypertension. Included studies: Park et al [ 23 ]; Sookaneknun et al [ 24 ]; Carter et al [ 29 ]; Carter et al [ 30 ]; Garçao, Cabrita [ 34 ]; Hirsch et al [ 35 ]; Morgado, Rolo, Castelo-Branco [ 39 ]; Skowron, Polak, Brandys [ 42 ]; Stewart et al [ 43 ]; Tsuyuki et al [ 45 ]; Vivian [ 46 ]; Wang et al [ 47 ]; Bajorek et al [ 48 ]; Carter et al [ 49 ]; Abdel-Hameed et al [ 51 ]; Fikri-Benbrahim et al [ 52 ].…”

“…Forest plot of blood pressure reduction in the subgroup analysis for the study quality score. Included studies: Park et al [ 23 ]; Tsuyuki et al [ 45 ]; Sookaneknun et al [ 24 ]; Hirsch et al [ 35 ]; Vivian [ 46 ]; Carter et al [ 29 ]; Morgado, Rolo, Castelo-Branco [ 39 ]; Carter et al [ 30 ]; Garçao, Cabrita [ 34 ]; Fikri-Benbrahim et al [ 52 ]; Skowron, Polak, Brandys [ 42 ]; Stewart et al [ 43 ]; Wang et al [ 47 ]; Bajorek et al [ 48 ]; Carter et al [ 49 ]; Abdel-Hameed et al [ 51 ].…”

“…( B ) Forest plot for diastolic blood pressure Forest plot of blood pressure reduction in the subgroup analysis for the MTM-PC insertion scenario. Included studies: Park et al [ 23 ]; Sookaneknun et al [ 24 ]; Garçao, Cabrita [ 34 ]; Skowron, Polak, Brandys [ 42 ]; Stewart et al [ 43 ]; Bajorek et al [ 48 ]; Fikri-Benbrahim et al [ 52 ]; Carter et al [ 29 ]; Carter et al [ 30 ]; Hirsch et al [ 35 ]; Vivian [ 46 ]; Morgado, Rolo, Castelo-Branco [ 39 ]; Wang et al [ 47 ]; Carter et al [ 49 ]; Abdel-Hameed et al [ 51 ]; Tsuyuki et al [ 45 ].…”

“…Forest plot of blood pressure reduction in the subgroup analysis for the MTM-PC models. Included studies: Park et al [ 23 ]; Sookaneknun et al [ 24 ]; Carter et al [ 30 ]; Hirsch et al [ 35 ]; Stewart et al [ 43 ]; Tsuyuki et al [ 45 ]; Vivian [ 46 ]; Bajorek et al [ 48 ]; Carter et al [ 49 ]; Carter et al [ 29 ]; Morgado, Rolo, Castelo-Branco [ 39 ]; Garçao, Cabrita [ 34 ]; Fikri-Benbrahim et al [ 52 ]; Skowron, Polak, Brandys [ 42 ]; Wang et al [ 47 ]; Abdel-Hameed et al [ 51 ].…”